We’re happy to report that both pregnancy and the Mediterranean Diet are featured in the newly released 2020-2025 Dietary Guidelines for Americans. 

One of the most exciting updates in these newly released Dietary Guidelines is the focus on cultural diets, like the Mediterranean Diet. According to the US government’s Guidelines, “customizing the Dietary Guidelines framework to reflect specific cultures and traditions is an important strategy to help communities across the country eat and enjoy a healthy dietary pattern.”  In terms of a healthy dietary pattern, the Mediterranean Diet was called out as one to follow (along with a healthy vegetarian/vegan diet and a healthy American-style diet).  

Further, another recent and timely announcement came from a scientific panel assembled by US News & World Report.  This report on January 4, 2021 proclaimed the Mediterranean Diet as the #1 Overall Best Diet (as well as the #1 Easiest to Follow, #1 Plant-Based Diet, #1 Heart-Healthy Diet, #1 Best Diabetes Diet and #1 Best Diet for Healthy Eating.)  

For the first time, the Dietary Guidelines included an entire section on healthy eating during pregnancy and lactation.  The Mediterranean Diet fits all the recommendations for pregnant and lactating women:  fruits, vegetables, whole grains, nuts, healthy oils, dairy, meat, poultry, and seafood.   

In terms of advice about following a healthy Mediterranean Diet for pregnant and lactating women, we turned to Elizabeth Ward, MS, RD, author of Expect the Best:  Your Guide to Healthy Eating Before, During and After Pregnancy.  Her advice? The Mediterranean Diet is a good way to get the baby the nutrients that he or she needs, as well as nurturing the mother’s body.  It’s associated with the right amount of weight gain and provides a lower risk for complications such as gestational diabetes, the form of diabetes that occurs during pregnancy (see below for more information about gestational diabetes). One thing she cautions about is folate. It’s important to have enough folate when pregnancy occurs in order to prevent neural tube defects, which can occur during the first 30 days of pregnancy. In addition to following the Mediterranean Diet, Elizabeth Ward also recommends conceiving in the best possible way—women wanting to become pregnant should plan ahead and start taking folate supplements. (See more about folate below.)

Nutrition studies also confirm the benefits of following a Mediterranean Diet for pregnant women. A 2019 study in the UK of 1,252 pregnant women found a Mediterranean-style diet led to a 35% lower risk of developing gestational diabetes, which is one of the greatest health risks during pregnancy.  The diet included a high intake of nuts, extra virgin olive oil, fruit, vegetables, non-refined grains and legumes, and moderate to high consumption of fish. The diet also resulted in less weight gain during pregnancy.  Similarly, a study of 874 pregnant women in Spain consuming a Mediterranean Diet proved to have a 25% lower risk of developing gestational diabetes. Although there is not an answer to why the Mediterranean Diet is protective against gestational diabetes, one of the Spanish study authors theorized that the high antioxidant, anti-inflammatory characteristics of the Mediterranean diet may be one reason for this preventive benefit. 

In Today’s Dietitian, a researcher at the Imperial College in London noted that while more research should be done to understand the mechanisms that provide for the Mediterranean Diet’s protective qualities related to gestational diabetes, there is enough evidence to recommend the Mediterranean Diet to women who are pregnant or want to be pregnant. 

Special considerations:  The US Dietary guidelines also highlighted special nutritional considerations for pregnant women such as meeting nutrient needs for folate [1], iron [2], iodine [3], and choline [4].  Seafood, alcohol and caffeine consumption were also called out for special consideration for pregnant and lactating women, as was food safety. 

Seafood:  The Dietary Guidelines recommend seafood intake during pregnancy, as it is associated with favorable measures of cognitive development in young children.  Women who are pregnant or lactating should consume at least 8 and up to 12 ounces of a variety of seafood per week, from choices lower in methylmercury.  For more information on seafood to consume during pregnancy, the National Fisheries Institute (NFI) has a very useful and informative guide:  The Pregnant Woman’s Guide to Eating Seafood.  Need help with the how-to? Check out NFI’s new seafood e-cookbook.  You’ll find a recipe for Salmon Avocado Boats in this Fresh Friday. 

Alcohol:  Although you might see pregnant women sipping martinis in movies and television from the 1950s, it should be no surprise that pregnant women are advised not to consume alcohol.  The guidelines state: “It is not safe for women to drink any type or amount of alcohol during pregnancy.  Alcohol can harm the baby at any time during pregnancy, even during the first or second month when a woman may not know she is pregnant.”  After birth, if breastfeeding, it is recommended to refrain from drinking.  “However, moderate consumption of alcoholic beverages by a woman who is lactating (up to 1 standard drink in a day) is not known to be harmful to the infant, especially if the woman waits at least 2 hours after a single drink before nursing or expressing breast milk.” 

Caffeine:  The guidelines recognize that most women consume low to moderate amounts of caffeine during pregnancy and lactation, but also note that “women who could be or who are pregnant should consult their healthcare providers for advice concerning caffeine consumption.” 

Food Safety:  Women who are pregnant or lactating, “need to take special care to keep foods safe and to not eat foods that increase the risk of foodborne illness.”  Specifically, meat, poultry, eggs and seafood should be cooked to a safe internal temperature (the safe temperature changes depending upon the food).  In addition, raw or unpasteurized juices, milk, and cheese should be avoided. As delicious as raw milk cheese is, pregnant women should choose among the many wonderful artisanal or traditional cheeses made from pasteurized milk.  

Pleasures of the Table:  Finally, being pregnant doesn’t mean not enjoying great meals.  In concert with the positive health benefits of the Mediterranean Diet for women who are pregnant, lactating, or want to become pregnant, is the undeniable truth that the Mediterranean way of eating tastes really good. Nurturing new life should be fun and delicious as well as providing the nutrients necessary to support the growth and development of the baby and to maintain the mother’s health. Santé!

Footnotes from the 2020-2025 US Dietary Guidelines for Americans.

[1] The RDA for folate is higher during pregnancy and lactation than all other life stages. Adequate folic acid intake is particularly important prior to conception and during the first trimester to help prevent neural tube defects. 

[2] Iron is a key nutrient during pregnancy that supports fetal development.

[3] Adequate iodine intake during pregnancy is important for neurocognitive development of the fetus. 

[4] Adequate intake of choline during these life stages helps to both replenish maternal stores and support the growth and development of the child’s brain and spinal cord.

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